Provider Demographics
NPI:1023409315
Name:SCHROEDER, JAN (LPCC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 NIQUEL PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1578
Mailing Address - Country:US
Mailing Address - Phone:505-261-1703
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW STE 309C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1425
Practice Address - Country:US
Practice Address - Phone:505-261-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0172151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health